A new precedent in international health cooperation from African public health leaders
Authors: Fabian Moser, Mahlet Kifle Habtemariam, Frode Forland, Benjamin Djoudalbaye
Journal: The Lancet Global Health (2023)

African public health leaders are setting a precedent for productive international health cooperation. The second International Conference for Public Health in Africa on Dec 13–15, 2022, in Kigali, Rwanda, epitomised this power to align the efforts of a rising continent. Africa's highest-level public health conference saw 2500 participants from 90 countries (87% of them from Africa) showcase the richness and confidence of African public health science and practice, with lessons to learn by countries beyond this region. The New Public Health Order (NPHO) for Africa was a recurring theme at the conference and is at the heart of this new way of driving positive health outcomes on the continent and beyond. This concept has provided a compass to the Africa Centres for Disease Control and Prevention's (Africa CDC) actions against public health threats since its inception1Nkengasong J Djoudalbaye B Maiyegun O A new public health order for Africa's health security.Lancet Glob Health. 2017; 5: e1064-e1065Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar and was elaborated by inaugural director, Dr John Nkengasong, with four pillars in 2020:2Nkengasong JN Tessema SK Africa needs a new public health order to tackle infectious disease threats.Cell. 2020; 183: 296-300Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar strengthening African institutions for public health, strengthening the public health workforce, expanding local manufacturing of health products, and promoting action-oriented and respectful partnerships. There has already been progress on each pillar. Besides the International Conference for Public Health in Africa, first initiated and reinforcing links among the continent's public health ecosystem in 2021,3Machingaidze S Ndembi N Binagwaho A Fisseha S Nkengasong J A united call for new public health order for Africa–the inaugural International Conference on Public Health in Africa (CPHIA 2021).J Public Health Afr. 2022; https://publichealthinafrica.org/index.php/jphia/issue/download/29/4Date accessed: February 16, 2023Google Scholar examples of progress include the promotion of National Public Health Institutes across the continent,4Africa Centres for Disease Control and Prevention African Union CommissionStrengthening and establishing national public health institutes as part of a network of the africa centres for disease control and prevention.https://africacdc.org/download/strengthening-and-establishing-national-public-health-institutes-as-part-of-a-network-of-the-africa-centres-for-disease-control-and-prevention/Date: 2018Date accessed: February 16, 2023Google Scholar with most African countries now establishing or having established a National Public Health Institute,5Desta HT Mayet N Ario AR Tajudeen R Role of national public health institutes for a stronger health system in Africa.Fortune J Health Sci. 2022; 5: 603-609Google Scholar training of public health leaders through the Kofi Annan Global Health Leadership Programme,6Africa Centres for Disease Control and Prevention African Union CommissionKofi Annan global health leadership programme.https://africacdc.org/kofi-annan-global-health-leadership-programme/Date accessed: February 16, 2023Google Scholar and increased opportunities for vaccine manufacturing across Africa.7Africa Centres for Disease Control and Prevention African Union CommissionCommunique on progress made on vaccine manufacturing in Africa—Kigali, Rwanda 06 07 December 2021.https://allafrica.com/stories/202112150026.htmlDate: 2021Date accessed: February 16, 2023Google Scholar Testament to the importance of the New Public Health Order, African Heads of State and Government in 2022 have called for its full implementation and added the fifth pillar of increasing domestic investment in health.8Africa Centres for Disease Control and PreventionAfrican Union CommissionCall to action: Africa's new public health order.https://africacdc.org/news-item/call-to-action-africas-new-public-health-order/Date: 2022Date accessed: February 16, 2023Google Scholar The NPHO is a framework around which member states and the many public health leaders and institutions of the continent can join forces, harmonise, and maximise national and regional public health assets to jointly guarantee Africa's health security.9Ouma Ogwell A Habtemariam Kifle M Machingaidze S Africa's new approach to public health.https://globalhealthnow.org/2022-11/africas-new-approach-public-healthDate: 2022Date accessed: February 18, 2023Google Scholar The NPHO implies a change in the narrative of cooperation from a continent that is being helped to one that is taking charge of its destiny. The agenda is based on African interests, localises resources to African (local) institutions and priorities and embraces partnerships that contribute to the achievement of these interests. It is therefore an investment into the long-term public health capabilities of its nations and the region, with obvious benefits to global health security. These are intuitive elements for effective international health cooperation, which matter not only for the African context. But they are not widely matched by the current practice and power balance of global health. Europe can learn much about public health from a strong, self-confident, optimistic, and new Africa. The African response to the COVID-19 pandemic, the ongoing implementation of the NPHO, and the latest International Conference for Public Health in Africa showcased Africa's ability to lead and practice public health not only as a science but also to understand its political implications.10Binagwaho A Machingaidze S Africa needs to take the lead in shaping the future of health on the continent.BMJ. 2022; 379o2999PubMed Google Scholar The launch of Africa CDC's Ministerial Executive Leadership Program for Ministers of Health across Africa on Feb 18, 2023, further supports the powerful NPHO roadmap on which African countries and initiatives converge. European public health leaders should take notes on how to inspire and lead continental direction and coordination for public health. Europe launched its EU Global Health Strategy on Nov 30, 2022, but it is missing a strong integrative policy framework to guide its continental public health development. Another learning point is digitisation, which is moving faster in many areas in Africa than in Europe, whereby monitoring, infection tracking, communication, health information, and money go directly from smartphones into digital networks. Change is needed, and it is time that African health is based on African priorities. The NPHO represents Africa's priorities for its health security. It constitutes a paradigm shift and new vision that seeks to transcend and inform the work of Africa CDC, the African Union, African Union member states, and development partners, guided by the principles of local and continental ownership and leadership, equity, wholesome and sustainable investment in health systems and universal health coverage, innovation, and self-reliance. A shift in global health cooperation towards holistic health systems investment, local and national leadership in setting priorities, and respectful, long-term, and action-oriented partnerships are crucial to realising the NPHO. FM acknowledges funding from Africa CDC to support travel to and attendance of a workshop where he served as a resource person. MKH, FF, and BD declare no competing interests.